Fentanyl awareness day: The synthetic opioid fentanyl increasingly poisons young Americans

In 2023, the Drug Enforcement Agency seized 74.5 million pills containing fentanyl.[i] This record-breaking number helps to explain why so many young people are experiencing unintended fentanyl poisonings. This article explores the risks and why young people are more susceptible to the dangers of taking, and dying from, illicitly manufactured fentanyl pills.


Charlie, was just 22 when he overdosed and died after taking what he thought was a Percocet that he’d bought over the internet. It turned out to be a fake pill that contained illicit fentanyl.[ii] The opioid epidemic began as a situation fuelled by prescription painkillers has evolved into a crisis driven by synthetic opioids, predominantly illicit fentanyl and fentanyl analogues.[iii] More and more people are dying from opioid overdoses, and it’s predicted the deaths could rise to 1.2 million by 2029.[iv] It can be hard to comprehend the enormity of this number or feel its potential impact at a time that’s half a decade from now. It is perhaps easier but no less stark to consider that in 2022, an average of 22 adolescents (people aged 10-19) died of drug overdoses in the US every week - the equivalent of a classroom of young people.[v] Between 2019 and 2020, overdose deaths in young people aged between 14 and 18 years increased by 94.03%, and between 2020 and 2021, they rose by 20.05%.[vi] The rise in young people’s deaths is happening despite a fall in drug use among young people and is strongly associated with the rise in counterfeit pills.


Illicitly drug manufacturers are pressing fentanyl into counterfeit pills

Illicitly manufactured fentanyl and other synthetic opioids have been part of the illegal drug market for the last several years and are now the most commonly found drugs involved in overdose deaths.[vii] Fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine.[viii] The legal version, or FDA approved fentanyl, is used by physicians to treat patients with severe pain, such as following surgery, or late-stage cancer. Illicit fentanyl is made using chemical processes so it can be produced in large quantities, cheaply and quickly. Drug manufacturers are pressing fentanyl into counterfeit pills that are made to look just like legitimate prescription drugs, such as oxycodone (ie: Percocet) and benzodiazepines (ie: Xanax).


A tiny amount of fentanyl can be deadly

The increasing prevalence of counterfeit pills in the US is particularly concerning for young people, who may be experimenting with prescription pills and are unaware of the dangers. Illicit fentanyl is so potent that just a tiny amount can be deadly and someone buying a pill would have no way of knowing what it contains without testing it. The overdose risks are even greater for those who don’t have an opioid use disorder and may be experimenting with drugs for the first time. Data from July 2019-December 2019 to July 2021–December 2021 for adolescents showed that 83.9% of deaths involved illicit fentanyl but only 35% had a known history of taking opioids, and counterfeit pills were detected in 24.5% of overdose deaths.[ix]


Buying online is a seemingly easy way for young people to get pills

Young people are more likely than adults to engage in behaviours that put them at risk of harm.[x] Their brains are still developing, and the prefrontal cortex, the area responsible for rational thinking and decision making, matures in someone’s mid-to-late twenties. Teenagers are influenced by peer relationships and are more likely to experiment socially, which can lead to positive and negative behaviors. This, coupled with the stresses that they often face related to, friendship issues, exams, going to college and entering the world of work, can trigger experimentation with drugs and alcohol. Mental health conditions are known to increase a person’s risk of using substances. Adolescent mental health was disproportionately affected during the pandemic and declared to be a national emergency in 2021.[xi] Buying online is a seemingly easy way for young people to get pills and drug traffickers are targeting young people on social media by using colorful icons and emojis to promote counterfeit pills.[xii] They’re a powerful way for dealers to sell to young people who are at increased risk of making poor decisions and acting impulsively due to their undeveloped brains.


Social media companies are taking actions curbing the development

The Drug Enforcement Agency (DEA) says that it’s working with social media companies and on the Dark Web to catch people using these means to sell drugs.[xiii] Social media companies are also taking action to prevent harm on their sites. For example, Facebook is using proactive detection technologies to find and stop drug-related content.[xiv] However, with  7 out of every 10 fake fentanyl pills containing a potentially lethal dose, there’s so much more to do.[xv] Adolescents need to know about counterfeit pills and how they can keep themselves and their friends safe.[xvi] By giving people the knowledge they need to make informed decisions, we can protect more lives and reduce the stigma associated with mental illness and opioid use disorder.


Educating young people is paramount

By breaking the chain between dealers and the adolescents buying pills from them, we can change the drug landscape and make it harder to sell to our children. Educating young people about how to recognize an overdose is paramount, particularly in light of the potency of illicit fentanyl and how quickly it acts. Access to rescue medications is essential, as well as knowing what to do in the critical moments that could be the difference between life and death. We all have a responsibility to give adolescents and the people they interact with at schools, colleges, and in social spaces the knowledge and tools they need to stay safe, make healthy choices and have equitable access to high quality and holistic healthcare.


Written by Georgina Hoy



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Orexo is a Swedish pharmaceutical company with over 25 years of experience developing improved pharmaceuticals based on proprietary formulation technologies that meet large medical needs. On the US market, Orexo provides innovative treatment solutions for patients suffering from opioid use disorder and adjacent diseases. Products targeting other therapeutic areas are developed and commercialized worldwide with leading partners. Total net sales in 2023 amounted to SEK 639 million, and the number of employees to 116. Orexo is listed on Nasdaq Stockholm's main list and is available as an ADR on OTCQX (ORXOY) in the US.


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[i] https://www.dea.gov/onepill

[ii] https://songforcharlie.org

[iii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154745/

[iv] https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00043-3/fulltext

[v] https://www.newswise.com/pdf_docs/170449618370215_FriedmanTeenOD2022.pdf

[vi] https://jamanetwork.com/journals/jama/fullarticle/2790949

[vii] https://pubmed.ncbi.nlm.nih.gov/32191688/

[viii] https://www.cdc.gov/stopoverdose/fentanyl/index.html

[ix] https://www.cdc.gov/mmwr/volumes/71/wr/mm7150a2.htm

[x] https://www.nimh.nih.gov/health/publications/the-teen-brain-7-things-to-know

[xi] https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/?_ga%C2%A0=%C2%A02.148070580.226118470.1666026568-1362783567.1666026568

[xii] https://www.dea.gov/sites/default/files/2021-12/Emoji%20Decoded.pdf

[xiii] https://www.dea.gov/stories/2021/2021-07/2021-07-23/counterfeit-drugs-social-media

[xiv] https://about.fb.com/news/2022/03/community-standards-enforcement-report-q4-2021/

[xv] https://www.dea.gov/onepill

[xvi] https://songforcharlie.org/take-action/